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NCCN Guidelines Index
Breast Cancer Table of Contents
Discussion
Version2.2015, 03/11/2015© National Comprehensive Cancer Network, Inc. 2015,All rights reserved.The NCCN Guidelines
®
and this illustration may not be reproduced in any form without the express written permission of NCCN
®
.
Note: All recommendations are category 2A unless otherwise indicated.
Clinical Trials: NCCN believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged.
BINV-K
4 OF 7
NCCN Guidelines Version 2.2015
Invasive Breast Cancer
DOSING SCHEDULE FOR COMBINATIONS FOR HER2-POSITIVE DISEASE: PREFERRED REGIMENS
OTHER REGIMENS LISTED
ON NEXT PAGE
See References
(BINV-K 7 of 7)
The selection, dosing, and administration of anti-cancer agents and the
management of associated toxicities are complex. Modifications of drug dose
and schedule and initiation of supportive care interventions are often necessary
because of expected toxicities and individual patient variability, prior treatment,
and comorbidity. The optimal delivery of anti-cancer agents therefore requires a
health care delivery team experienced in the use of anti-cancer agents and the
management of associated toxicities in patients with cancer.
AC followed by T chemotherapy with trastuzumab
15
• Doxorubicin 60 mg/m
2
IV day 1
• Cyclophosphamide 600 mg/m
2
IV day 1
Cycled every 21 days for 4 cycles.
Followed by:
Paclitaxel 80 mg/m
2
by 1 h IV weekly for 12 wks
With:
• Trastuzumab 4 mg/kg IV with first dose of paclitaxel
Followed by:
• Trastuzumab 2 mg/kg IV weekly to complete 1 y of treatment. As an
alternative, trastuzumab 6 mg/kg IV every 21 days may be used following
the completion of paclitaxel, and given to complete 1 y of trastuzumab
treatment.
Cardiac monitoring at baseline, 3, 6, and 9 mo.
AC followed by T chemotherapy with trastuzumab + pertuzumab
• Doxorubicin 60 mg/m
2
IV day 1
• Cyclophosphamide 600 mg/m
2
IV day 1
Cycled every 21 days for 4 cycles.
Followed by:
• Pertuzumab 840 mg IV day 1 followed by 420 mg IV
• Trastuzumab 8 mg/kg IV day 1 followed by 6 mg/kg IV
• Paclitaxel 80 mg/m
2
IV days 1, 8, and 15
Cycled every 21 days for 4 cycles
• Trastuzumab 6 mg/kg IV day 1
Cycled every 21 days to complete 1 y of trastuzumab therapy
Cardiac monitoring at baseline, 3, 6, and 9 mo.
Dose-dense AC followed by paclitaxel chemotherapy with trastuzumab
16
• Doxorubicin 60 mg/m
2
IV day 1
• Cyclophosphamide 600 mg/m
2
IV day 1
Cycled every 14 days for 4 cycles.
Followed by:
• Paclitaxel 175 mg/m
2
by 3 h IV infusion day 1
Cycled every 14 days for 4 cycles.
With:
• Trastuzumab 4 mg/kg IV with first dose of paclitaxel
Followed by:
• Trastuzumab 2 mg/kg IV weekly to complete 1 y of treatment. As an alternative,
trastuzumab 6 mg/kg IV every 21 days may be used following the completion
of paclitaxel, and given to complete 1 y of trastuzumab treatment.
Cardiac monitoring at baseline, 3, 6, and 9 mo.
TCH chemotherapy
17
• Docetaxel 75 mg/m
2
IV day 1
• Carboplatin AUC 6 IV day 1
Cycled every 21 days for 6 cycles
With:
• Trastuzumab 4 mg/kg IV wk 1
Followed by:
• Trastuzumab 2 mg/kg IV for 17 wks
Followed by:
• Trastuzumab 6 mg/kg IV every 21 days to complete 1 y of trastuzumab therapy
Cardiac monitoring at baseline, 3, 6, and 9 mo.
TCH chemotherapy + pertuzumab
18
• Trastuzumab 8 mg/kg IV day 1 followed by 6 mg/kg IV
• Pertuzumab 840 mg IV day 1 followed by 420 mg IV
• Docetaxel 75 mg/m
2
IV day 1
• Carboplatin AUC 6 IV day 1
Cycled every 21 days for 6 cycles
Followed by:
• Trastuzumab 6 mg/kg IV every 21 days to complete 1 y of trastuzumab therapy
Cardiac monitoring at baseline, 3, 6, and 9 mo.